Minilaparotomy-assisted transmesenteric approach for portal vein recanalization and transjugular intrahepatic portosystemic shunt in a non-cirrhotic patient with portal cavernoma

David, Arthur; Métairie, Sylvie; Perret, Christophe; Schnee, Matthieu; Archambeaud, Isabelle; Frampas, É.; Douane, Frédéric

doi:10.1016/j.diii.2019.12.004

Cited by 2 publications

(2 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar to mTIPS, several routes for gaining access to the portal system are emerging in PVS intervention, even though the portal vein has been obliterated and becomes a fibrotic cord. These multimodality cutting-edge therapeutic approaches, which encompass transjugular, transhepatic-intrahepatic portal vein branch using US guidance, transsplenic-US guidance, trans-ileocolic-mini-laparotomy (i.e., hybrid approach), as well as the trans-recanalized paraumbilical vein either alone or in combination, push the development of PVS ( Figure 3 ) ( 93 , 99 , 111 – 115 ). Transhepatic-intrahepatic portal vein branch using US guidance has been by far the most common way of gaining access to perform PVS ( 116 ).…”

Section: Interventional Vascular Therapiesmentioning

confidence: 99%

Optimal Treatment for Patients With Cavernous Transformation of the Portal Vein

2022

View full text Add to dashboard Cite

Cavernous transformation of the portal vein (CTPV) is a sequela of extrahepatic and/or intrahepatic portal vein obstruction caused by a combination of local and risk factors. It was ever taken as a relatively rare disease due to its scant literature, which was mainly based on clinical series and case reports. CTPV often manifests as gastroesophageal variceal bleeding, splenomegaly, and portal biliopathy after the long-term insidious presentation. It is unable for CTPV to be recanalized with anticoagulation because it is a complete obstruction of the mesentericoportal axis. Endoscopic therapy is mainly used for temporary hemostasis in acute variceal bleeding. Meso-Rex shunting characterized by portal-flow-preserving shunts has been widely performed in children with CTPV. The multitude of complications associated with CTPV in adults can be effectively addressed by various interventional vascular therapies. With the ubiquity of radiological examinations, optimal treatment for patients with CTPV becomes important. Multivisceral transplantation, such as liver-small intestinal transplantation, may be lifesaving and should be considered for patients with diffuse mesenteric venous thrombosis.

show abstract

Section: Interventional Vascular Therapiesmentioning

confidence: 99%

Optimal Treatment for Patients With Cavernous Transformation of the Portal Vein

2022

View full text Add to dashboard Cite

show abstract

“…While it has been shown that precise puncture guidance in TIPS procedures is possible with contrast-enhanced CT and the option of 3D reconstruction [ 27 , 28 ], similar data for the imaging-based planning of PSSS are not available, and our study was conducted to fill this gap. Besides choosing between TIPS and PSSS, the combination of both is a feasible alternative for complex cases with extrahepatic disease and should be kept in mind in the pre-interventional planning [ 29 ]. In our collective, the main reason to prefer PSSS to TIPS in adults was a chronic extrahepatic portal vein occlusion.…”

Section: Discussionmentioning

confidence: 99%

Portosystemic shunt surgery in the era of TIPS: imaging-based planning of the surgical approach

et al. 2020

View full text Add to dashboard Cite

Purpose With the spread of transjugular intrahepatic portosystemic shunts (TIPS), portosystemic shunt surgery (PSSS) has decreased and leaves more complex patients with great demands for accurate preoperative planning. The aim was to evaluate the role of imaging for predicting the most suitable PSSS approach. Material and methods Forty-four patients who underwent PSSS (2002 to 2013) were examined by contrast-enhanced CT (n = 33) and/or MRI (n = 15) prior to surgery. Imaging was analyzed independently by two observers (O1 and O2) with different levels of experience (O1 > O2). They recommended two shunting techniques (vessels and anastomotic variant) for each patient and ranked them according to their appropriateness and complexity. Findings were compared with the actually performed shunt procedure and its outcome. Results The first two choices taken together covered the performed PSSS regarding vessels in 88%/100% (CT/MRI, O1) and 76%/73% (O2); and vessels + anastomosis in 79%/73% (O1) and 67%/60% (O2). The prediction of complex surgical procedures (resection of interposing structures, additional thrombectomy, use of a collateral vessel, and use of a graft interposition) was confirmed in 87%, resulting in 80% sensitivity and 96% specificity. Larger shunt vessel distances were associated with therapy failure (p = 0.030) and a vessel distance of ≥ 20 mm was identified as optimal cutoff, in which a graft interposition was used. There was no significant difference between MRI and CT in predicting the intraoperative decisions (p = 0.294 to 1.000). Conclusion Preoperative imaging and an experienced radiologist can guide surgeons in PSSS. CT and MRI provide the information necessary to identify technically feasible variants and complicating factors.

show abstract

Minilaparotomy-assisted transmesenteric approach for portal vein recanalization and transjugular intrahepatic portosystemic shunt in a non-cirrhotic patient with portal cavernoma

Cited by 2 publications

References 4 publications

Optimal Treatment for Patients With Cavernous Transformation of the Portal Vein

Optimal Treatment for Patients With Cavernous Transformation of the Portal Vein

Portosystemic shunt surgery in the era of TIPS: imaging-based planning of the surgical approach

Contact Info

Product

Resources

About